Provider Demographics
NPI:1538943014
Name:EVERETT, KRISTIN D (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 N US 31
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-9767
Mailing Address - Country:US
Mailing Address - Phone:317-882-5122
Mailing Address - Fax:
Practice Address - Street 1:6001 N US 31
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-9767
Practice Address - Country:US
Practice Address - Phone:317-882-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010316A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical